A U.S. government report expected to stir debate concluded that fluoride in drinking water at twice the recommended limit is linked with lower IQ in children.

The report, based on an analysis of previously published research, marks the first time a federal agency has determined — “with moderate confidence” — that there is a link between higher levels of fluoride exposure and lower IQ in kids. While the report was not designed to evaluate the health effects of fluoride in drinking water alone, it is a striking acknowledgment of a potential neurological risk from high levels of fluoride.

The long-awaited report released Wednesday comes from the National Toxicology Program, part of the Department of Health and Human Services. It summarizes a review of studies, conducted in Canada, China, India, Iran, Pakistan, and Mexico, that concludes that drinking water containing more than 1.5 milligrams of fluoride per liter is consistently associated with lower IQs in kids.

The report did not try to quantify exactly how many IQ points might be lost at different levels of fluoride exposure. But some of the studies reviewed in the report suggested IQ was 2 to 5 points lower in children who’d had higher exposures.

Since 2015, federal health officials have recommended a fluoridation level of 0.7 milligrams per liter of water, and for five decades before the recommended upper range was 1.2. The World Health Organization has set a safe limit for fluoride in drinking water of 1.5.

The report said that about 0.6% of the U.S. population — about 1.9 million people — are on water systems with naturally occurring fluoride levels of 1.5 milligrams or higher.